Virtual Utilization Review Manager

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

💰 Private Equity Round on 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• Responsible for the leadership and management of the centralized BSHSI Virtual Utilization Management Program • Maintain the support structure within the department for achieving clinical and operational excellence • Oversight of operational activities of the Virtual UM staff • Provide direct support and resources to Care Coordination to effectively improve LOS and excess days • Collaborate extensively with other members of the health care team • Accountable for meeting and managing departmental goals and budgets

🎯 Requirements

• 2 Year/ Associates Degree Nursing • Current unrestricted license to practice nursing in the resident State • MCG Certification required within 6 months of hire • Demonstrated advanced usage of AI and the management of teams using AI • Broad knowledge and skilled use of MCG or nursing criteria guidelines • Broad knowledge of insurance regulations and Medicare and Medicaid guidelines

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits • Career Advancement